Ihris in Senegal 2

TECHNICAL BRIEF | June 2021 iHRIS in Senegal 2

Context Senegal has made great strides in critical areas towards achieving universal health coverage, reducing high rates of maternal and child mortality and the incidence of communicable diseases. However, despite impressive results overall, the Senegalese health system faces many challenges that limit its ability to realize the vision of the SDGs, including health sector development. To address the important challenges in human resources for health (HRH), the Ministry of Health and Social Action (MSAS) has recognized the need for HRH data that is complete, accurate and up to date on the number, production and budget allocation of HRH. These data are essential for increasing and maintaining the availability, accessibility, acceptability and quality of HRH, as well as for developing evidence-based HRH policies and strategies. In 2014 the MSAS made the decision to implement iHRIS Manage, adapting to the national context, to meet the data needs of HRH with the support of the CapacityPlus Project, through IntraHealth, funded by the United States Agency for International Development (USAID), and the Human Resources Department (DRH). To implement the system, a task force was established bringing together programmers and central level managers responsible for monitoring IT aspects, training focal points, and the Senegalese IT Agency (see Figure 1).

Figure 1. Process for the Development of the iHRIS Task Force

Specifically, the Ministry of Health carried out the pilot phase of the use of the iHRIS software in two regions (Kaolack, Kolda) and the Central Level. The platform was introduced in four phases:

Phase 1 Phase 2 The preparatory phase: configuration, development of tools The implementation of the pilot project in two regions (with such as the identification sheet, the supervision guide for data different profiles) and at the central level. entry agents, etc.

Phase 3 Phase 4

Evaluation of the pilot phase and definition of scale up The scale up of enrollment to the remaining 12 regions strategies.

To continue these efforts, through the Human Resources for Health in 2030 (HRH2030) program funded by USAID, the USAID / Senegal mission is providing technical assistance to MSAS to strengthen its human resources management to ensure that quality health services are available to all parts of the country. By working directly with the MSAS through the HRD, HRH2030 helps build their capacity to support regions to operationalize effective human resource policies for responsive and equitably distributed health workers; and use data from health human resources information systems, iHRIS, in planning and management; and strengthen leadership to govern health workers fairly.

Revitalization of iHRIS Before HRH2030, iHRIS was deployed in all the regions, with data entered by agents recruited for this purpose, with focal points identified and trained to be able to continue to enroll and enter data. However, major problems were noted, some of which are highlighted in the following table: Major Problems Identified Non-use of the software by focal points due to lack of access code. Poor quality data entered in the initial database, with the existence of duplicates. Existence of data fields that were not translated into French. Low enrollment rate of health personnel in the software (only 47% of health workers in Dakar were enrolled). Focal point in charge of recruiting officers at the facility level receive low levels of support from supervisors. Lack of definition of roles and responsibilities of the designated iHRIS focal point. Non-availability of health personnel identification sheets. Lack of oversight over the functionality and use of iHRIS at all levels of human resources management. Of the HRH data entered into the iHRIS software, most was not deemed unusable.

Due to this, the iHRIS software was not used for decision making in human resource management. In view of these major problems, the MSAS started the process of revitalizing the iHRIS software in 2017, beginning with the strengthening of equipment and collaboration with key partners. During the revitalization, the following interventions were carried out.

Improvement of the functionality of iHRIS in its technical dimension: A technical evaluation of the functionality of iHRIS was carried out and the following problems were identified: a) the non-automatic regeneration of reports after entry; b) the server used was not suitable; c) the iHRIS version in use was outdated; d) there was no test server. To make the platform functional, a new server was purchased and made available, a customized version of the software was put in the test server hosted in the cloud. The automatic report generation script was developed and tested first on the test server before being made available on the production server.

Figure 2. Process of improving the functionality of iHRIS Harmonization of common parameters (variables) and nomenclatures (names) in relation to HR of the different health information systems: In particular, iHRIS, Health Card, DHIS2, the main directory of health structures "Master Facility List" was used in order to meet the need for comparison of data at the national, sub-regional and international level (West African Health Organization and World Health Organization). Specifically, variables on categories, professional groupings, types of structures, types of contracts, types of occupied and unoccupied positions, and position status was taken into account in the configuration. Retraining and support to human resource focal points: All the focal points and some managers (152) received either initial training or retraining after the tools were revised (software user guide, personnel identification form) and after the platform functionality was improved. Also, the heads of the HRD Division and the Focal Points of the Regions and health facilities benefited from training in data processing and analysis. This contributed to improving the quality of reports and improved decision making. Supportive supervision of focal points of medical regions and public health establishments: With a view to strengthening achievements and sustainability, supervision missions were regularly carried out to strengthen the ownership of iHRIS by stakeholders. Supervision identified difficulties such as: a) 49% of the designated focal points had not received an official appointment and therefore did not take any initiative related to the functionality of IHRIS, b) the lack of ownership by management teams due to a lack of knowledge of the software, c) the underuse of the software (24% of the focal points use it regularly), and d) incomplete information on the agents. The decisions taken during supervision improved the engagement of focal points. This improved engagement contributed to improved enrollment from 61% in 2017 to 91% in 2021 for nine key variables (Gender, Age, CSP, Name of the structure, Agent status, Type of contract, Employer, Department, Date of entry into the system). Governance of the platform: To monitor the implementation of the platform, the MSAS has set up a task force made up of representatives of the IT Unit and the Human Resources Department and the Directorate of Public Health Establishments. To ensure the regular updating of HR data, the ministry has drawn up an official memo (Lettre Circulaire) which obligates agents to be enrolled in the platform at the risk of not receiving their incentive allowance. 6

Development of the iHRIS Focal Point job description: A model job description has been developed at the national level. Where the model has been validated by the head of the structure, the completeness and quality of the information has improved, a direct result of the improved skills of the iHRIS Focal Point.

Collaboration with the State IT Agency (ADIE): ADIE is the technical body of the government in charge of overseeing the development of the government intranet. As such, with the support of the Head of the MSAS IT Unit who is the focal point of the State IT Agency, the Agency hosted and provides technical maintenance for the iHRIS server. The Human Resources Department, the IT unit, and the Agency work in collaboration for the functionality of the platform. Development of reports: Strengthening the skills of heads of divisions, heads of offices, and HR focal points of the other departments of the MSAS on processing and analysis of data related to HRH for semi- annual reports of health facilities and medical regions, the annual statistics report of HRH at national and regional level, and other dashboards and reports.

Use of Human Resources for Health Data to Make Decisions Due to this revitalization, the use of HRH data from the iHRIS platform has improved at all levels:

Winning couple. To improve the availability of Recruitment of specialist. At Kaolak Regional maternal child health services at the community level, Hospital, the wait for patients to receive medical

the MSAS has implemented the winning couple strategy imaging exams was very long. After analyzing the which consists of staffng a trained child health nurse human resources data in iHRIS, iHRIS focal point convinced the Hospital Director to advocate to the and midwife trained in basic obstetric and neonatal care in all the country's health centers. Using iHRIS, the Board of Directors to resolve the medical imaging national focal point at the HRD level identified all the technician gap. This reduced the wait time for patients. health centers that do not have the nurse/midwife couple and during recruitment and staff transfers these gaps have been taken into account. Now the majority of health centers in the country have had a winning couple. Telephone contact during COVID-19. The MSAS faced challenges in rapidly sharing information about the risks and modes of transmission of COVID-19 to all health care providers across the At Keur Massar Health Center, Planning of Training. country. To do this, a report was developed in the the operating theater was built, and the gynecologist iHRIS platform entitled "employee telephone hired, but the unit was not functioning due to the directory". The report provided the telephone absence of an instrument technician. The Director with contacts of all providers for the platform minfoSanté the support of the Human Resources Focal Point used to send SMS to all health personnel in the health

iHRIS to identify two health workers in the District for facilities to fight against the transmission of COVID- training. After this training, the Health Center was able 19. to open the operating room, which is now fully functional.

Lessons Learned and Recommendations for Sustainability Along with these accomplishments, the following lessons learned and recommendations were identified:

MANAGEMENT AND USE OF IHRIS Lesson Learned: With the improvement in the Recommendation: Require the updating of the availability of data in iHRIS, the system can be used for database to improve the completeness of the data the preparation of semi-annual reports on the human before the preparation of reports (Human Resources resources situation of medical regions and public health dashboards, Social report, Semi-annual reports, establishments, the social report and static directory. annual statistical report on HRH). Lesson Learned: Due to the training of Focal Points Recommendation: Perform regular data quality at all levels, there is a significant increase in data quality, assessment activities. Fill in all the information that is not only registration rate (number of health personnel in the HRH identification form. Validation of the enrolled in the system out of the actual number) but identification sheets by the Focal Point and also the completeness of data from the identification supervisor. sheet. Lesson Learned: As the quality of data increases, the Recommendation: Take into account all health software has the ability to analyze the availability and personnel involved in the provision of care regardless distribution of health personnel across the country, of the employer and the type of contract to assess which can be used to assess the accessibility of the availability of sufficient and quality care. Propose sufficient and quality health care provision for all the staff movements by referring to reports produced levels of the health pyramid. from the iHRIS platform. Lesson Learned: An official memo “Lettre Circulaire” Recommendation: Inform health personnel about requiring enrollment in the iHRIS platform to benefit the memo and continue data updates. from the financial incentive awarded by the MSAS improved availability and quality of data in iHRIS.

BUILDING CAPACITY OF LEADERS INVOLVED IN THE MANAGEMENT OF HUMAN RESOURCES Lesson Learned: By improving the ability of managers Recommendation: Provide an account to all involved in the management of HRH to use all the managers who participate in decision-making on functionalities of iHRIS Manage, led to increased human resources, limiting the accessibility of private ownership of the system. data. Example: HRH private information should be accessible only to the manager. Lesson Learned: To increase the culture of data use, Recommendation: Organize and promote reviews improved the capacity of managers to process, analyze based on factual HRH data at all levels for monitoring and interpret human resources statistics. the performance of healthcare personnel. Also, increase training on the use of data.

SUPERVISION OF MAIN STAKEHOLDERS Lesson Learned: Supportive supervision helped Recommendation: Strengthen the supportive strengthen and complement the skills of focal points on supervision of iHRIS focal points to ensure the quality the use of the iHRIS platform. of data entry. Lesson Learned: Supportive supervision has made it Recommendation: Continue support through possible to strengthen the use of statistics on human annual supervision the analysis and interpretation of resources by decision-makers at all levels. statistics on human resources with a focus on preparing the various reports.

INSTITUTIONALIZATION OF THE IHRIS PLATFORM Lesson Learned: The management of iHRIS by the Recommendation: The person in charge who Head of the Division of Planning for Jobs and Skills was manages statistics on HRH at the Ministry must be in critical to improving the management of the platform. charge of the management of the iHRIS platform. Lesson Learned: The use of iHRIS has sparked the Recommendation: Continue to raise awareness commitment of decision makers at all levels to take an among decision makers on the availability, quality and interest in the use of health human resources statistics. usefulness of iHRIS human resources statistics.

OPTIMAL USE OF IHRIS DATA TO IMPROVE ACCESS TO HEALTH SERVICES Recommendation: Use iHRIS in new approaches to evaluating the performance of healthcare staff. Monitor the performance of healthcare personnel according to socio-professional category through routine health statistics. Recommendation: Use iHRIS to monitor the equitable distribution of personnel, taking into Lesson Learned: Due to the revitalization of iHRIS in account difficult areas. Set up regional staff transfer Senegal and the strengthening of the skills of focal commissions that decide on staff distribution in the points and managers, the use of statistics on human region, using iHRIS. resources has allowed decision-making to improve the Recommendation: Use iHRIS to determine the real coverage of the health care. needs in qualified human resources by structure. Analyze HRH data to determine needs across workload. Recommendation: Operational research is necessary and important. Develop operational research or impact study on policies and strategies for retaining personnel in difficult areas and other surveys.

Conclusion and Next Steps Based on the experience of the implementation of iHRIS in Senegal and the pursuit of the countries health objectives, investments in the human resources information system must continue: 1. Migrate to iHRIS version 5.0 which allows for the ability to work offline, among other features of version 5.0. Offline operations will improve the registration rate of health personnel and the rate of data completeness by ensuring continuous data entry even in the absence of the internet. 2. In addition to the iHRIS Manage module, activate the iHRIS Train module for the planning and management of trainings to support an understanding on the availability of health personnel in the labor market. 3. Develop a feature in the iHRIS platform that provides the status of the completeness of the data of enlisted personnel. This functionality will visualize the level of variables completed in each personnel record giving a clear idea on where the Focal Points should focus efforts. The DHIS2 model to show completeness (number of agents enrolled) and internal completeness (number of variables entered) can be used. 4. To improve analyzes on issues related to the health system, develop interoperability between health information subsystems. Sharing data from the iHRIS platform with other information sub-systems belonging to the health system improves the quality and use of information from the iHRIS platform. 5. Continue to develop the culture of using HRH data in the country. All decisions should be based on information obtained from statistical data. It is through the use of information on human resources that health actors can make better informed decisions on related issues. With these perspectives, and the lessons learned, the strengthening of the functionality of iHRIS will continue to grow, ensuring the availability of data for use by stakeholders in the management of human resources. Ultimately contributing evidence to achieve the country's health objectives and ensure health for all.

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This material is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of cooperative agreement no. AID-OAA-A-15-00046 (2015-2021). The contents are the responsibility of Chemonics International and do not necessarily reflect the views of USAID or the United States Government.

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